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Shin, Kim, Hwang, Kim, Lee, Choi, Kim, and Park: Improvement of Type 2 Diabetes after Bariatric Surgery in a Patient with Severe Obesity
Original Articles & Case Reports

J Korean Diabetes 2011;12(1):53-59.

Published online: 22 January 2011

DOI: https://doi.org/10.4093/jkd.2011.12.1.53

Improvement of Type 2 Diabetes after Bariatric Surgery in a Patient with Severe Obesity

Mi-Seon Shin1, Joo Hui Kim1, Jenie Yoonoo Hwang1, Eun Hee Kim1, Woo Je Lee1, Youn-Baik Choi2, Kab Choong Kim2, Joong-Yeol Park1

1Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

2Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Copyright © 2011 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The prevalence of obesity is steadily increasing worldwide and is commonly associated with metabolic diseases including hypertension, hyperlipidemia, and type 2 diabetes as well as increased mortality. Bariatric surgery is an effective treatment modality for patients with severe obesity and type 2 diabetes that are refractory to conventional treatments. We performed bariatric surgery (biliopancreatic diversion with duodenal switch) in a 23-year-old man with severe obesity and uncontrolled type 2 diabetes. Before surgery, the patient experienced continuous weight gain and aggravated glycemic control despite dietary restrictions, exercise, and medications including high dose insulin. After surgery, his weight was reduced by 17 kg and he was able to stop insulin treatment. This case suggests that bariatric surgery is an effective therapeutic option when severe obesity and type 2 diabetes are refractory to usual treatments.

Keywords: Bariatric surgery, Obesity, Type 2 Diabetes Mellitus

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Fig. 1.
Schematic of the biliopancreatic diversion with duodenal switch procedure. Sleeve gastrectomy was performed. The duodenum was divided immediately beyond the pylorus and the alimentary limb was connected to the duodenum while the biliopancreatic limb was connected to the ileum (75 cm) proximal to the ileocecal valve.
jkd-12-53f1.tif
Fig. 2.
Subcutaneous fat (between open arrow and arrow head) and intraperitoneal fat (inside of dot line arrow) was measured by fat computed tomography. (A) Three months prior to operation. (B) Five months after operation.
jkd-12-53f2.tif
Table 1.
Indications for bariatric surgery for the treatment of severe obesity (adapted from NIH conference Ann Intern Med 1991;115:956-61 [11])
BMI ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 with significant obesity-related co-morbidities
Age between 16 and 65 years
Acceptable operative risks
Documented failure of nonsurgical approaches to longterm weight loss
Psychologically stable patient with realistic expectations
Well-informed and motivated patient
Commitment to prolonged lifestyle changes
Supportive family/social environment
Resolution of alcohol or substance abuse
Absence of active psychosis and untreated severe depression
Table 2.
Perioperative anthropometric and biochemical changes
Time Preoperative Postoperative (1 mo) Postoperative (4 mo) Postoperative (7 mo)
Anthropometric
 Height (cm) 166.5 166.5 166.5 166.5
 Weight (kg) 110.1 97 100.4 100
 BMI (kg/m2) 39.72 34.99 36.22 36.07
 Waist/hip ratio 0.98 0.98
 SBP/DBP (mm Hg) 125/84 123/75 136/67 137/69
 Body fat mass (kg) 44.2 35.9
 Percent body fat (%) 40.2 35.7
 Subcutaneous fat (cm2) 420.1 342.56
 Intraperitoneal fat (cm2) 276.5 186.77
Biochemical
 Fasting glucose (mg/dL) 261 141 155 174
 PP 120 min (mg/dL) 339 113 198 169
 HbA1c (%) 11.5 7.2 7.9
 Fasting insulin (µU/mL) 41.9 5.5
 Urinary albumin excretion (µg/min n) 52.7 24.5
 C-peptide (ng/mL) 1.4 2.6
 Hemoglobin (g/dL) 16.5 14.4 15.4
 Total cholesterol (mg/dL) 274 161 173
 HDL cholesterol (mg/dL) 48 49 52
 LDL cholesterol (mg/dL) 67 96 96
 Triglyceride (mg/dL) 1012 137 244
 AST (IU/L) 18 18 29 33
 ALT (IU/L) 25 15 29 48
 Creatinine (mg/dL) 0.9 0.7 0.7 0.8
 hs CRP (µg/mL) 0.19 0.1
 Apolipoprotein A1 (mg/dL) 186.4 131.3
 Apolipoprotein B (mg/dL) 112.7 74.3 84.8
 Apolipoprotein E (mg/dL) 6.9 3.9
 HOMA-IR (mg/dL x µU/mL)a 27 2.1

BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; PP, post prandial; HDL, high density lipoprotein; LDL, low density lipoprotein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; hs CRP, high sensitive C-reactive protein.

a Homeostatic model assessment for insulin resistance; fasting glucose (mg/dL) x fasting insulin (µU/mL)/405.

Table 3.
Perioperative changes of plasma glucose during the oral glucose tolerance test
Preoperative (mg/dL) Postoperative (10 days) (mg/dL)
0 min 225 150
30 min 382 210
60 min 444 269
90 min 411 285
120 min 329 232
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